Tibial Spine Fractures: Open Treatment
A tibial spine fracture is a bony avulsion of the attachment of the anterior cruciate ligament. These fractures are most commonly seen in skeletally immature children and adolescents aged 8–14 years, as the bone is the point of failure with the anterior cruciate ligament (ACL) actually being stronger in resisting tensile forces than the incompletely ossified tibial plateau. These are often sports-related injuries with a mechanism similar to that of ACL tears in adults, mainly hyperextension combined with a valgus or rotational force. In up to 40% of cases, there may be associated injury to the meniscus, capsule, or collateral ligaments (LaFrance et al. 2010). Tibial spine fractures are classified by the degree of displacement (Meyers/McKeever classification): type I is nondisplaced, type II is anterior cortical displacement with an intact posterior hinge, and type III is a completely displaced fragment. A type IV was added later which is a comminuted fragment. The goals of treatment are to restore the integrity and function of the ACL along with the normal contour of the tibial plateau.